Intracranial ultrasonographic screening of premature babies meeting the criteria

Mallikarjuna G. P., B. S. Prasad, Akhil M. Kulkarni, N. K. Kalappanavar


Background: The preterm infant brain is most vulnerable to both haemorrhagic and ischemic injury during the late second and early third trimesters.  This is due to vascular, cellular, and anatomical features of the developing brain and the tendency of preterm infants to experience periods physiological instability at a time when they have limited cerebral circulatory auto regulation. CUS is useful for recording PVH, PVL, measurement of resistive index and ventricular dilatation. The study was to determine the magnitude of abnormal intracranial findings among the preterm neonates admitted in NICU of S.S. Institute of Medical Science and Research Centre, Davangere by using cranial ultrasonography.

Methods: The study was intended to do CUS in pre-terms with gestation age of less than 32 weeks or those with birth weight of less than 1500 grams irrespective of gestational age and Preterm with abnormal neurological presentation. Infants enrolled were divided in to groups according to gestational age, birth weight and results analysed by using Epi info version 6 software, p value <0.05 is considered significant.

Results: Most common abnormalities found is intra ventricular haemorrhage (7.8%), ventricular dilatation (1%), agenesis of corpus callosum (1%). There is significant correlation between birth weight and gestational age (p value <0.05) and prevalence of intra ventricular haemorrhage in <28 weeks (group 1) is more (15. 4%), compared to group 2 (28-32weeks), and group 3 (>32 weeks).

Conclusions: The prevalence of Intra ventricular haemorrhage is significantly higher as the gestational age decreases. Neonatologist can take ethical decisions depending on intracranial abnormalities as it changes line of management. CUS helps in directing the families of affected infants towards most appropriate follow up and to promote early intervention for chronic neurodevelopmental sequelae of haemorrhagic or ischemic injury. So, all neonatologist working in NICU should be trained in CUS. 


Cranial ultrasound, Germinal matrix, Infant, Intraventricular haemorrhage, Preterm, Periventricular haemorrhage, Periventricular leukomalacia, Ventricular dilatation, Very low birth weight

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Volpe JJ. Brain injury in the premature infant. Neuropathology,clinical aspects,pathogenesis and prevention. Clin Perinatol. 1997;24:567-87.

Cohen HL. Neurosonography of the infant: The normal examination. In: Timor-Trisch, Monteagudo A,Cohen HL,eds. Ultrasonography of the Prenatal and Neonatal Brain. Stamford:Appleton and Lange;1996:259-85.

Volpe JJ. Bacterial and fungal intracranial infections. In: Volpe JJ ed. Neurology of the newborn. WB Saunders Company: Philadelphia. 2001a.

Volpe JJ. Intracranial haemorrhage: germinal matrix-intra ventricular haemorrhage of the premature infant. In: Volpe JJ ed. Neurology of the newborn. WB Saunders: Philadelphia;2001c.

American Institute of Ultrasound in Medicine Standards for performance of the ultrasound examination of the infant brain. 2006 Available at www.

British Medical Ultrasound Society Ultrasound in medicine, 2006. Available at www. bmus. org.

Ancel PY, Livinec F, Larroque B, Marret S, Arnaud C, Pierrat V. Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics. 2006;117(3):828-35.

Arthur R, Ramenghi Imaging the neonatal brain. In: Levene MI, et al eds Fetal and neonatal neurology and neurosurgery. Churchill Livingstone: London;2001.

Bracci R, Perrone SN, Buonocore G. The Timing of Neonatal Brain Damage. Biol Neonate. 2006;90:145-5.

Back SA, Rivkees SA. Emerging concepts in periventricular whitematter injury. Seminperinatol. 2004;28(6):405-14.

Virkola K. The lateral ventricle in early infancy. Thesis, Helsinki. 1988. ISBN; 952-90012-9-0.

Stark JE, Seibert JJ. Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia. J Ultrasound Med. 1994;13:595-600.

BMUS. British Medical Ultrasound Society. 2007. Available at safety statement.asp.

Kost GJ. Goals, guidelines and principles for point-of-care testing. Principles and practice of point-of-care testing. 2002:3-12.

vanWezel MG. Neonatal cranial ultrasonography: guidelines for the procedure and atlas of normal ultrasound anatomy. New York: Springer. 2007;1:14-37.